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-� FOR'°-OFFICE USE: <br /> IpppLlCATlO- <br /> ------------- i-- -_--y TOSANITATION <br /> PERMIT I <br /> Permit No: <br /> (Complete in Triplicate) <br /> ----------'------------------ --------------------------- <br /> ----------------------------------------- --------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> 4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install"tthe worI&I'erein� <br /> F described. This annh—flon,is-made in compliance with- County Ordinance No. 549 and existing Rules and Regulations: <br /> - J�,. .1 I <br /> JOB ADDRESS/[OCATION ` f� � ___: _ I _ - ---------------------- ---------------- --------.----CENSUS TRACT ---911---------------- <br /> Owner's Name 1_LL----------j`-4�--VDINT—------------------------ -------------------Phone ------------------------------------ <br /> Addreas 1 5 'N-_0V +! _ i1 ------------------------------------------- City ------------ C_4LL <br /> Contractor's Name ---------,,5 ------------------------------------------License # ------ ---------------- Phone ----------------------------- <br /> -------Installation will serve. Residence Q� Apartment House-E] Commercial ❑TrciilerjCourt [I <br /> Motel ❑Other --------------------------------'' F° i <br /> Number of living units:--'I. ---- <br /> __ Number of bedrooms _e2.-----Garbage Grinder _V.(-- Lot Size <br /> Water Supply: Public System�ahcl name _ ? ---------w��Z. -_{3Rou'g;WT-----W' i GS <br /> y--,--- --- Private ❑ <br /> Character of soil to a depth of 3 feet: Sand.[� Silt ❑ Clay ❑ PeatV Sandy Loam ❑ Clay Loam ❑ y <br /> Hardpan ❑ Adobe❑ Fill Material---_- ______ If yes;type .____---------------._ j <br /> I <br /> (Plot pian, showing size of lot, location,of-system in relation to wells,, Buildings, etc. 'must be placed on reverse side.) <br /> NEW INSTALLATION {No septic tank or seeJJ <br /> page pit permitted if publicewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size____))Q 01 ----_--`- <br /> -PACKAGE TREATMENT SEPTIC TANK-4 Size---- ----------------- Liquid Depth ____________________,.__- <br /> Capacityl6D.Q. , -Type FORkMate rial-PNo. Compartments _____________ <br /> Distance to n arestl Well -------AJ__i _-_-_- Prop. Line ._ <br /> Foundation _-A� Alt -------------------- <br /> CtEACHING LINE ' No. of Lines _ _ ___j-- ---- Length of each .line___- _fl f_______________ Total LengthQ_--______________ <br /> 'D' Box ------------ Type Filter Material _ Depth Filter Material - - ------------------------- <br /> Distance to nearest: Well -___—_____------- Focindation ------------------------ Property Line ------------------ <br /> SEEPAGE PIT [ ? Depth ______________ ___ Diameter _______________ Number ----------------------------- Rock Filled Yes j] No .❑ <br /> Water Table Depth=-_�k-------------------- --.---..._.Rock Size ------------------------- <br /> Distance to�nearest: Well ----------------------------------------Foundation --------------------- Prop. Line ---------------------- J <br /> REPAIRJADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- <br /> Septic <br /> ________________________________ - ) <br /> ---------------- <br /> I i <br /> Se tic Tank (Specify Requirements) ---- ----�-�-��--3---------� L_� .-----��_�------- --•.------------------ -------- <br /> A { P Y q <br /> Disposal Field (Specify Requirements] �_ ___-_ <br /> ----- - <br /> -- GOIV ------------�kD0_Q-0-------- -ffoa- --------- <br /> --- -a- t s----- oa fE " a <br /> ----------------------------- <br /> k(Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and-.that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to bepcome subject to Workman's Compensation laws of California." <br /> Signed [ `eMev_ .LL. :i TC �-�---------------------- Owner { <br /> BY ----- ---------------------------------------------------------------- Title -------------- <br /> ( other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY r �' DATE 2-7 �`'L <br /> - ----------------- <br /> BUILDING PERMIT ISSUED ------ ------ - ------------------------------- ----- ----- --------- ---------------------------- ---DATE -------------•--------------- ------ <br /> ADDITIONAL COMMENTS --------------` <br /> ---------------------------------------------------------=------------------------------------------------- <br /> --------------------------------------- )----------------------- ------------------------------------------------------------------ ------------------ <br /> I --- ---------- -------- <br /> Final Inspection by.. J -- - ----------•-----------------�----------------------------------- -•------.Date <br /> - -- ----------------------------- ------------ - --------------------------------------------------------------------------- -------------- <br /> - ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M / `� <br />